Evidence map›Paper›PMID 32005992›Full record

Trial reportThe American journal of clinical nutrition2020

Delayed iron improves iron status without altering malaria risk in severe malarial anemia.

Sarah E Cusick, Robert O Opoka, Andrew S Ssemata, Michael K Georgieff, Chandy C John

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The American journal of clinical nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01093989 (Acute vs. Delayed Iron Therapy), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01093989 nacompletednot on this map

Acute vs. Delayed Iron Therapy: Effect on Iron Status, Anemia and Cognition

TypeinterventionalSponsorUniversity of MinnesotaRan2010 to 2014Enrolled239ConditionsAnemia, Inflammation, Malaria Morbidity, Cognitive DevelopmentArmsFerrous Sulphate Syrup
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 10 citations in OpenAlex.

  1. Trial
  2. Review
  3. Observational
  4. Observational
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 2 countries.

Sarah E CusickDepartment of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Robert O OpokaDepartment of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Andrew S SsemataDepartment of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Michael K GeorgieffDepartment of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Chandy C JohnDepartment of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.
University of Minnesota · USMakerere University · UG

Funding

Severe Malaria And Risk to The Brain (SMART Brain)R01NS055349 · NINDS · UNIVERSITY OF MINNESOTA · PI Chandy C. John, Ruth Namazzi · 2008 to 2026
$11.2M
Research training in infection, nutrition and neurodevelopment in UgandaD43TW010928 · FIC · INDIANA UNIVERSITY INDIANAPOLIS · PI Chandy C. John · 2018 to 2026
$1.9M
Research Training in Infection and Neurodevelopment in UgandaD43NS078280 · NINDS · UNIVERSITY OF MINNESOTA · PI JOHN, CHANDY C. · 2011 to 2015
$1.1M
Acute vs. delayed iron therapy: effect on iron status, anemia and cognitionU01HD064698 · NICHD · UNIVERSITY OF MINNESOTA · PI JOHN, CHANDY C. · 2009 to 2013
$916k
FIC NIH HHS D43 TW010928NICHD NIH HHS U01 HD064698NINDS NIH HHS D43 NS078280NINDS NIH HHS R01 NS055349
6 · The paper itself

Abstract

backgroundWHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode.

objectivesWe aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk.

methodsWe conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n = 79) or severe malarial anemia (SMA; n = 77). Asymptomatic community children (CC; n = 83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo.

resultsAll children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP ≥ 80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P = 0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P = 0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12).

conclusionsIn children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.

Indexed as

AnemiaAntimalarialsChild, PreschoolFemaleFerrous CompoundsHemoglobinsHumansInfantMalaria, CerebralMaleAntimalarialsFerrous Compoundsferrous sulfateHemoglobinscerebral malariainflammationiron and malariairon deficiencymalariasevere malarial anemiazinc protoporphyrin

Identifiers

PMID32005992
PMCPMC7198296
OpenAlexW3003239415

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.